Jakob Emerson reports for Becker’s Hospital Review that at least 17 large hospital systems are dropping their Medicare Advantage contracts this year. As we’ve seen over the last couple of years, hospitals are making clear that Medicare Advantage enrollees risk not getting needed care in a timely manner, if at all. In addition, with hospitals refusing to be part of Medicare Advantage networks, Medicare Advantage enrollees are struggling to access hospital services.
More than 30 million older adults and people with disabilities are now enrolled in Medicare Advantage plans. The insurers offering Medicare Advantage plans mislead them to believe that they will get all the benefits of Medicare and more, as they should, in Medicare Advantage. But, report after report shows that Medicare Advantage enrollees face huge obstacles to care when they most need it. They face bureaucratic prior authorization hurdles when they have cancer, or need rehab or skilled nursing services as well as other costly treatments. Their Medicare Advantage plans too often deny them critical care.
Hospital systems offer several reasons why they are ending their Medicare Advantage contracts. The biggest reason, by far, is that Medicare Advantage plans deny care excessively through their prior authorization processes. And, when patients get care, Medicare Advantage plans too often do not reimburse the hospitals for the care they get.
A recent survey of 135 health system CFOs by the Healthcare Financial Management Association found that 16 percent intend to end contracts with at least one Medicare Advantage plan in the next two years. Nearly half of them reported that they are considering cancelling their Medicare Advantage contracts. Sixty-two percent said that it had become increasingly more difficult to get the Medicare Advantage plans to pay for the care the hospitals provide.
UnitedHealth and Humana are the two insurers with the largest share of Medicare Advantage enrollees. They appear to be among the worst offenders when it comes to prior authorization abuses and denied payments from the hospital systems’ perspective.
In Canton, Ohio Aultman Health System is ending its hospital and physician contracts with Humana Medicare Advantage. Med Health System in Albany, New York, Power Health in Munster, Indiana, Memorial Hermann Health System in Houston, Texas, WellSpan Health in York, Pennsylvania, Christiana Care in Newark, Delaware, EcuHealth in Greenville, North Carolina, and Genesis Healthcare System in Zanesville, Ohio either have cancelled or will cancel their Humana Medicare Advantage contracts this year.
Comanche County Memorial Hospital in Lawton, Oklahoma is ending its UnitedHealthcare Medicare Advantage contract as is Samaritan Health Services in Carvallis, Oregon and Health Partners in Bloomington, Minnesota.
Powers Health and MyMichigan Health are cancelling their Aetna Medicare Advantage contracts.
Genesis Healthcare System also dropped its Anthem BCBS Medicare Advantage contract.
Here’s more from Just Care:
- Underpayments lead hospitals and specialists to cancel Medicare Advantage contracts
- How prior authorization requirements in Medicare Advantage could threaten your health
- Medicare Advantage offers less care at greater cost
- OIG finds widespread inappropriate care denials in Medicare Advantage
- Medicare Advantage and other HMOs compromise continuity of care
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